Anxiety About the Risk of Death of Their Patients in Health Professionals in Spain: Analysis at the Peak of the COVID-19 Pandemic

The Psychopathological Predictors and Effects of Death Anxiety

Death anxiety has been linked to several psychopathological conditions. However, the causes, comorbidity, and differential diagnosis of death anxiety is unexplored. This paper stands out by identifying common predictors of death anxiety and exploring the potential of death anxiety as a predictor for other psychological conditions. The paper reports the findings of four consecutive studies that involved a total of 2291 conveniently selected participants including 861 men and 1430 women. We focused on clarifying both the predictors of death anxiety and the psychopathological consequences emerging from it. Our findings established depression, anxiety, stress, fear of aging, and reduced life satisfaction as predictors of death anxiety. Psychosocial illness, sleep disturbances, aggression, and daily hassles were established as the adverse outcomes of death anxiety. Fear of aging was the most significant predictor of death anxiety and daily hassles emerged as the most significant adverse consequence of death anxiety.

Studying daily fluctuations of emotional effort among nurses of intensive care units: the establishment of latent profiles and its relationship with daily secondary traumatic stress and vitality

Introduction

Nursing professionals working in Intensive Care Units (ICU) face significant challenges that can result in secondary traumatic stress (STS). These challenges stem from witnessing patients' suffering and managing difficult tasks (i.e. communication with patients' relatives). Furthermore, these professionals encounter emotional demands, such as emotional effort, which is the dissonance between the emotion felt and the emotion that should be expressed to meet work expectations. Consequently, we aimed to investigate whether different profiles exist concerning nurses' levels of emotional effort over a five-day period and whether these profiles are related to daily STS and vitality.

Methods

The sample comprised 44 nursing professionals from ICUs in Spanish hospitals. They were assessed daily, using a package of questionnaires twice per day for five working days: a) immediately after their shift and b) at a later time after working.

Results

The findings revealed three distinct profiles based on emotional effort levels: high (Profile 1), moderate (Profile 2), and low (Profile 3). These profiles were found to be negative predictors for both daily shattered assumptions and symptomatology.

Discussion

This study underscores the importance of assessing daily emotional demands in an ICU setting. Such assessments are crucial for establishing preventive measures to help nursing professionals manage lower-level emotional demands.

Mental Health Changes in Healthcare Workers During COVID-19 Pandemic: A Systematic Review of Longitudinal Studies

This study provides an overview of research findings on long-term effects on healthcare workers mental health and factors associated with positive or negative changes. Medline and PubMed databases were searched for observational longitudinal studies and 18 papers were included in the review (PROSPERO: CRD42021260307). 12 articles indicated negative changes over time and six studies revealed a positive trend in a variety of mental health outcomes (anxiety, depression, insomnia, and others). Female sex, younger age, nursing occupation, frontline work, longer working hours and concerns about contracting COVID-19 were identified to be associated with negative changes. Conversely, a supportive environment, access to psychological resources, provision of sufficient personal protective equipment and availability of COVID-19 tests were linked to positive changes. Therefore, our findings can assist governmental and institutional authorities with effective interventions to improve psychological care for healthcare workers.

Death Anxiety Associated With Coronavirus (COVID-19) Disease: A Systematic Review and Meta-Analysis

Death anxiety is a feeling that exists since birth, continues throughout life, lies at the root of all fears, and develops after the awareness that people will no longer exist and that they can lose themselves and the world. It is associated with death-induced anxiety with many features of the COVID-19 pandemic, which can be seen as a threat to human existence. In this study, it is aimed to compile studies on death anxiety associated with coronavirus disease, list the general characteristics of these studies through descriptive summaries, and combine findings on the level of death anxiety associated with coronavirus disease through meta-analysis. The findings of this study suggest that COVID-19 pandemic process and is affected by socio-demographic factors such as fear of COVID-19, gender, and occupation. As a result of this study, it was determined that death anxiety was relatively high during the COVID-19 pandemic process.

Death Anxiety Among Pakistani HCWs: The Role of COVID-19 Vaccine Acceptance and Positive Religious Coping Strategy

Background: The mental health of healthcare workers (HCWs) has been significantly impacted by the COVID-19 pandemic. To address this, spirituality and religious coping mechanisms have been suggested as a way to maintain well-being and reduce anxiety levels. Additionally, vaccination has been shown to play an essential role in lowering anxiety levels, including death anxiety. However, there is a lack of evidence on how positive religious coping strategies and COVID-19 immunization affect death anxiety levels. To fill this gap, this study uses a Pakistani HCWs sample. Methods: This study collected cross-sectional data from 389 HCWs on socio-demographics, positive religious coping strategies, vaccine acceptance, and death anxiety. Hypothesis testing was done using Statistical Package for the Social Sciences (SPSS) and Partial Least Squares (PLS) by adopting the Structural Equation Modeling (SEM) technique. Results: The results showed that the positive religious coping strategy and acceptance of the COVID-19 vaccine reduced death anxiety among HCWs in Pakistan. HCWs practicing the positive religious coping strategy and vaccine acceptance had lower levels of death anxiety symptoms. Thus, the positive religious coping strategy has a direct effect on reducing death anxiety. Conclusion: In conclusion, COVID-19 immunization positively affects individual mental health by reducing death anxiety. Vaccines protect individuals from COVID-19 infection, providing a sense of security that reduces the chance of death anxiety among HCWs attending to COVID-19 patients.

Anxiety Levels and Coping Strategies to Deal with COVID-19: A Cross-Cultural Study among the Spanish and Latin American Healthcare Populations

Given its impact, COVID-19 has engendered great challenges in terms of health, highlighting the key role of health personnel. This study aims to analyze the level of anxiety, as well as coping strategies, among the health personnel in Latin American countries and Spain. An exploratory, descriptive, quantitative, cross-sectional study was conducted with 584 participants from the healthcare population. No significant differences were observed in anxiety levels due to COVID-19 between Latin American countries and Spain. In Spain, an active and passive coping style is used, while in Latin American countries, an avoidance coping style is employed; there is a direct correlation between anxiety levels and the avoidance coping style. There exists an inverse correlation between anxiety levels and the use of an active coping style; moreover, there are no significant differences in the anxiety level of health personnel depending on whether they have cared for patients with COVID-19. Low cognitive activity, use of the avoidance method and Spanish geography were the main predictive coping styles of anxiety. Effective measures are required for preserving the mental health of health professionals during pandemics.

Frontline Involvement in Population COVID-19 Vaccinations: Lived Experience of Nursing Students

(1) Background: The globally promoted vaccination campaign has been shown to be the solution for the COVID-19 pandemic, reducing transmission, hospitalisation and the need for intensive care. Although several studies have examined the experiences of healthcare workers during the pandemic, few studies have investigated healthcare student experiences. The aim of this study is to explore the lived experience of third-year nursing students during the COVID-19 vaccination campaign. (2) Methods: A phenomenological qualitative method was adopted. The researchers selected third-year students undertaking a bachelor’s nursing degree who took part in the COVID-19 vaccination campaign at a high-volume vaccination centre in the period from May to August 2021. (3) Results: Thirteen students were included in the study. Three themes and twelve subthemes emerged from the study. The themes were: a challenging experience; it is not as easy as it seems; a learning experience worth living; and teamwork and trust leading to professional development. (4) Conclusions: Participation in the vaccination campaign was a novelty for students in their degree program. Students emphasized the positive aspects of having the opportunity to participate in the vaccination campaign and help the entire community in the fight against COVID-19.

The Relationship Between Thanatophobia Levels and Attitudes Towards Caregiver Roles Among Nurses in the COVID-19 Period

The current study aimed to determine the relationship between fear of death and their caregiver roles in nurses during the COVID-19. The research data were collected with the personal information form, the Thanatophobia scale, the Scale of Nurses' Attitudes to Their Caregiver Roles (SNACR), the Google Questionnaire Form. Of the nurses participating in the study, 16.1% were diagnosed with COVID-19. The current study found statistically significant differences among the thanatophobia mean scores of the groups composed according to the variables; age, gender, marital status, job position, voluntarily choosing the profession, satisfaction with the department, having had a COVID-19 diagnosis, personal assessments about their own COVID-19 knowledge, and evaluating the COVID-19 disease as fatal. In addition, there were statistically significant differences among the SNACR mean scores of the groups according to their evaluations about gender, income level, working experience as a nurse, being diagnosed with COVID-19, and their COVID-19 knowledge. The current study found no correlation between the nurses' Thanatophobia scale score and SNACR score.

"We Were Afraid": Mental Health Effects of the COVID-19 Pandemic in Two South African Districts

The impacts of pandemics are recognized to go beyond infection, physical suffering, and socio-economic disruptions. Other consequences include psychological responses. Using a mental wellbeing lens, we analyzed COVID-19-related stressors in healthcare workers (HCWs) and community members who provided and regularly accessed health services in South Africa, respectively. From February to September 2021, during the second COVID-19 wave we conducted a qualitative study in one urban and one rural district. In-depth interviews and focus group discussions were used to collect data among 43 HCWs and 51 community members purposely and conveniently selected. Most participants experienced mental health challenges regarding multiple aspects of the COVID-19 pandemic and its resulting lockdown, with a few reporting positive adjustments to change. COVID-19 impacts on mental health were consistent among both HCWs and community members in urban and rural alike. Participants' COVID-19-induced psychological responses included anxiety and fear of the unknown, perceived risk of infection, fear of hospitalization, and fear of dying. Physical effects of the pandemic on participants included COVID-19 infection and associated symptoms, possibilities of severe illness and discomfort of using personal protective equipment. These distresses were exacerbated by social repercussions related to concerns for family wellbeing and infection stigma. Lockdown regulations also intensified anxieties about financial insecurities and social isolation. At times when common coping mechanisms such as family support were inaccessible, cultural consequences related to lack of spiritual gatherings and limited funeral rites posed additional stress on participants. In preparation for future public health emergencies, recognition needs to be given to mental health support and treatment.

“The worst thing that has happened to me”: Healthcare and social services professionals confronting death during the COVID-19 crisis

Objectives

This study analyzes the subjective emotional impact COVID-19 deaths have had on healthcare, social services, and funeral services professionals, it explores the different implications, and analyzes the different reactions of health and social care professionals and funeral professionals to the volume of deaths.

Methods

This work is based on a qualitative, phenomenological, and interpretative approach through in-depth interviews with 42 informants, including 36 social and healthcare professionals, as well as 6 family members of those who died from COVID-19 in Madrid. The interviews were processed through a qualitative, interpretative, categorical analysis.

Results

Healthcare professionals were overexposed to a significant number of deaths under dramatic circumstances. Many of these professionals had difficulties processing their experiences and expressed the need for psychological help. The fact that certain professionals had previous exposure to high mortality rates was not a protective factor. Some coping differences were seen between healthcare professionals and professionals dedicated to the care of the deceased (undertakers or firemen), particularly in the degree to which they personalized the care they provided.

Conclusion

The overexposure to death with the circumstances that existed during the state of emergency had a significant emotional impact on the professionals, which can lead to mental health problems in the near term.

A Systematic Review of Death Anxiety and Related Factors Among Nurses

This systematic review aimed to summarize the evidence regarding death anxiety (DA) and related factors among nurses. Scopus, PubMed, Web of Science, Iranmedex, and Scientific Information Database (SID) databases were extensively searched using purpose-related keywords from the earliest to October 5, 2021. A total of 6819 nurses were included in 31 studies. The DA of nurses based on the Templer's Death Anxiety Scale was moderate. Factors such as personal anxiety, frequency and severity of job stress, burnout, dying patient avoidance behavior, euthanasia, sex, mental health status, social desirability, attitude toward the elderly, humor, social maturity, psychological hardiness, quality of life, lack of social activity, self-efficacy, coping with death, and life satisfaction were associated with nurses' DA. Therefore, nursing policymakers can promote nurses' health to improve the quality of nursing care by considering these related factors.

Analysis of the Psychosocial Impact of the COVID-19 Pandemic on the Nursing Staff of the Intensive Care Units (ICU) in Spain

(1) The public health emergency, caused by COVID-19, has resulted in strong physical and mental exhaustion in healthcare workers. This research has been designed with the aim to describe the psychosocial impact of the COVID-19 pandemic on nurses working in intensive care units (ICU) and identify the related risk factors. (2) This is a cross-sectional study, in which a self-administered questionnaire was designed to cover the dimensions of interest associated with psychosocial factors during the pandemic and their factor risks. (3) A total of 456 nursing professionals participated, and 88.4% were women. Most of the professionals had a temporary contract (71.3%) and person at risk close to them (88.8%). Regarding psychosocial factors, there was a worsening in most of the associated variables, especially in sleep problems, anxiety, stress, and job performance. Female nurses were more prone to anxiety. Those under 30, as well as those with temporary contracts, were more unfocused. Professionals with a person at risk in their environment felt much more worried. The degree of exposure was associated with greater fear. (4) Those nurses who were female, younger, and with a temporary employment contract were shown to be more vulnerable to the impact of the pandemic on their psychosocial health. Because of this, it is necessary to adopt effective strategies for the protection of nurses’ health, focusing on the specific risk factors identified.

Burnout and well-being of healthcare workers in the post-pandemic period of COVID-19: a perspective from the job demands-resources model

Background

The present study aimed 1) to examine the effects of epidemic-related job stressors, perceived social support and organizational support on the burnout and well-being of Chinese healthcare workers in the period of COVID-19 regular epidemic prevention and control and 2) to investigate the moderating effects of social support and organizational support on the relationship between job stressors and burnout and well-being within the theoretical framework of the Job Demands-Resources (JD-R) model.

Methods

A sample of healthcare workers (N = 3477) from 22 hospitals in Beijing, China participated in the cross-sectional investigation in October 2020 and reported epidemic-related job stressors, perceived social support, organizational support, burnout, anxiety and depression symptoms.

Results

1) Medical doctors, females, people aged from 30 to 50, and those who worked in the second line during the pandemic reported higher scores of psychological symptoms and burnout in the period of regular epidemic prevention and control; 2) Epidemic-related job stressors positively predicted burnout, anxiety, and depression among healthcare workers; 3) Perceived social support and organizational support were negatively related to reported burnout, anxiety and depression symptoms; 4) Social support reduced the adverse effects of epidemic-related job stressors on anxiety and depression but enhanced the association between stressors and burnout; 5) Organizational support mitigated the adverse effects of epidemic-related job stressors on depression.

Conclusion

The results shed light on preventing burnout and enhancing the psychological well-being of healthcare workers under epidemic prevention and control measures by reducing epidemic-related job stressors and strengthening personal and organizational support systems.

The Impact of the COVID-19 Pandemic on Burnout, Compassion Fatigue, and Compassion Satisfaction in Healthcare Personnel: A Systematic Review of the Literature Published during the First Year of the Pandemic

This literature review aimed to determine the level of burnout, compassion fatigue, and compassion satisfaction, as well as their associated risks and protective factors, in healthcare professionals during the first year of the COVID-19 pandemic. We reviewed 2858 records obtained from the CINAHL, Cochrane Library, Embase, PsycINFO, PubMed, and Web of Science databases, and finally included 76 in this review. The main results we found showed an increase in the rate of burnout, dimensions of emotional exhaustion, depersonalization, and compassion fatigue; a reduction in personal accomplishment; and levels of compassion satisfaction similar to those before the pandemic. The main risk factors associated with burnout were anxiety, depression, and insomnia, along with some sociodemographic variables such as being a woman or a nurse or working directly with COVID-19 patients. Comparable results were found for compassion fatigue, but information regarding compassion satisfaction was lacking. The main protective factors were resilience and social support.

The Effect of Nurses' Death Anxiety on Life Satisfaction During the COVID-19 Pandemic in Turkey

The purpose of the study is to determine the effect of nurses' death anxiety on life satisfaction during the COVID-19 pandemic. This cross-sectional and correlational study was conducted with 411 nurses in Turkey. Data were collected online through Google Forms using a sociodemographic form, the Revised Death Anxiety Scale (RDAS), and the Satisfaction with Life Scale (SWLS). Percentages, means, Pearson's correlation analysis, and hierarchical linear regression models were used to analyze the data. The nurses' mean age was 28.11 (SD = 6.27) years. More than half of the nurses stated that there were COVID-19 patients in the clinic where they worked (56.0%) and that they were afraid to provide care to patients diagnosed with COVID-19 (54.5%). Their mean RDAS total score was 57.33 (SD = 16.20), indicating moderate death anxiety, and their mean SWLS total score was 2.58 (SD = 0.82), indicating a low level of life satisfaction. Sociodemographic variables accounted for 8.8% of the variance. Death anxiety was associated with life satisfaction (β =  - 0.118, p < 0.05). Model 3, which included all of the analyzed independent variables, explained 17% of the variance in life satisfaction (R² = 0.171, p < 0.001). This study showed that death anxiety adversely affects life satisfaction. Higher death anxiety among nurses was associated with lower satisfaction with life. Based on the findings, we recommend providing more psychological and communication support to nurses and implementing systematic physical and psychological evaluations of nurses to facilitate early intervention.

Death anxiety and burnout in intensive care unit specialists facing the COVID-19 outbreak: The mediating role of obsession with COVID-19 and coronaphobia

The aim of the study was to examine the role of the obsession with COVID-19 thoughts and coronaphobia in the relationship of death anxiety with burnout among staff working at infectious diseases hospitals in the front-line of the fight against COVID-19. A cross-sectional online survey (N = 110) was conducted during the second wave of the COVID-19 pandemic. Results showed that obsession with COVID-19 and coronaphobia mediated the relationship of death anxiety with burnout. Most of the participants reported higher levels of death anxiety compared with the general population and nurses reported higher levels of death anxiety than physicians.

Pandemic heroes or victims? Healthcare professionals’ well-being during Covid-19 pandemic

Introduction and aim: The SARS-CoV-2 pandemic had a significant impact on the mental condition of the society, increasing anxiety and fear for the future. High levels of anxiety, stress and depression have been observed in the general population. Nurses and doctors, who are in direct contact with patients and their body fluids, are at the highest risk of infection. The aim of this study was to look at the psychiatric health aspects of health care professionals in general during the pandemic.

State of knowledge: Work overload and stress-related symptoms make healthcare workers particularly vulnerable to mental distress, increasing the risk of developing mental disorders. Among them, women, students and nurses were most affected. A German study found that nurses working with COVID-19 patients in particular are mentally affected by the consequences of the pandemic. This may be due to the higher workload and the longer time spent in direct contact with COVID-19 patients compared to doctors. The available literature confirmed the construct of coronaphobia in health care workers. The issue of insufficient personalization of protective equipment and the associated feelings of fear and stigma as well as the need for psychological help are addressed and psychiatric services for healthcare professionals.

Material and methods: At the beginning of this year, 30 people from the clinical hospital in Lublin were surveyed using a questionnaire containing several questions concerning, among others, comfort of work in the current epidemiological situation, The Patient Health Questionnaire-9, The Generalized Anxiety Disorder-7 and Mini-COPE.

Conclusions: The work shows the mental health problems faced by health service representatives on a daily basis in connection with the pandemic that has been going on for many months. The features of depression-anxiety disorders affect the medical staff. The attitude of solidarity and cooperation of all members of society during the pandemic is important.

Use of MOOCs in Health Care Training: A Descriptive-Exploratory Case Study in the Setting of the COVID-19 Pandemic

This exploratory study is part of the training and innovation project (GID2016-16) of the National University of Distance Education (UNED) in Spain. The current socioeconomic and educational contexts derived from COVID-19 has led university institutions to develop methodological innovations in the teaching-learning process. Among these strengthening measures are the MOOCs, the most appropriate strategy to bring students closer to new digital platforms that favor the acquisition of knowledge. A methodological pluralism, combining quantitative and qualitative perspectives, has been used. The main results of the descriptive analysis compare the data of students enrolled in the MOOC, “Social and Health Care and Social Services in Social Work”, and other related bachelor’s and master’s degree courses during the four years analyzed. One of the conclusions is the emerging possibility of offering university studies that are more in line with the current teleworking market. The development of online methodologies favors the democratization of education, reaching the student body as a whole and universalizing content and learning. Among the main conclusions, it is worth highlighting the degree of satisfaction shown by the students who took advantage of the MOOC, and the training opportunities afforded by MOOC courses, during the time of COVID-19.

Spanish nurses' experiences with personal protective equipment and perceptions of risk of contagion from COVID-19: A qualitative rapid appraisal

AIMS AND OBJETIVES

Explore nurses' experiences and perception of risk regarding the use of personal protective equipment during the first wave of the pandemic in Spain.

BACKGROUND

The contribution of our study is to use qualitative methods to understand nurses' experiences and perceptions of the risk of the contagion linked to the shortage of PPE during the first wave of the pandemic, whose explosive start strained health systems around the globe.

DESIGN

Qualitative descriptive design according to the Rapid Research Evaluation and Appraisal model.

METHODS

Semi-structured videoconference interviews were conducted to explore the experiences of 29 nurses including staff nurses, nursing supervisors and nursing directors from hospital and community services of the Spanish health system. Interviews lasted 30-45 min and were conducted in May 2020. We carried out a thematic analysis using Dedoose. The COREQ checklist was used to report findings.

RESULTS

We identified the following themes and subthemes: 1. Experiences with personal protective equipment: scarcity, inequality, reutilization, self-protection, delegation of responsibility, and gap between protocols and reality; 2. Perception of the risk of contagion: lack of credibility, lack of trust, lack of support, and meeting subjective needs.

CONCLUSIONS

The scarcity of personal protective equipment and inequality in its distribution led nurses to take initiatives to feel more protected. Mid-ranking supervisors were caught between the responsibility of monitoring and rationing personal protective equipment and providing the necessary protection to nurses. The disjuncture between protocols and the available supply of personal protective equipment caused confusion. Lack of credibility, lack of trust and lack of support from management influenced participants' perception of the risk of contagion. Mid-ranking supervisors were often responsible for trying to alleviate fear among nursing staff.

RELEVANCE TO CLINICAL PRACTICE

Understanding the factors involved in risk perception can be helpful to decision-makers who help protect nurses in clinical practice. These results can help administrators and policymakers because they point to the need for nurses to feel that their departments and centers look after their safety at work. Transparent communication and emotional support may contribute to their well-being in the face of risk.

Resilience and anxiety among intensive care unit professionals during the COVID-19 pandemic

Background

The situation of the COVID‐19 global pandemic has generated an unprecedented state of emergency worldwide that has had a psychological impact on health care workers working in the ICU and this has created the need to implement different psychological strategies.

Aim

This study explores (a) the prevalence of symptoms associated with generalized anxiety disorder (GAD), (b) the relationship between GAD symptoms and resilience skills, and (c) which of the resilience skills were associated with a probable GAD among the ICU professionals during the COVID‐19 pandemic.

Study design

Cross‐sectional survey design.

Methods

We explored anxiety and resilience in 448 ICU health care workers using an online survey.

Results

The participants showed high resilience levels and more than half of them presented symptoms consistent with a possible diagnosis of GAD. The GAD symptoms were more prevalent among women, nursing assistants, interns, staff who worked on rotation and health care workers who had to attend to more than 20 COVID patients. Significant negative correlations between resilience skills and GAD symptoms were found. The multiple regression analysis showed that resilience skills contribute to 14.4% of the variance for GAD symptoms. The binary logistic regression showed that the only skill that had a significant and negative predictive effect was “I usually take things in my stride” (OR = 0.774, 95% CI 0.67, 0.88; P = .000). This ability was the differentiating skill between professionals who equal or exceed the cut‐off point established for the diagnosis of a probable GAD regarding those who do not.

Conclusion

ICU professionals developed symptoms consistent with a possible diagnosis of GAD due to their exposure to extremely stressful circumstances. However, resilience skills acted as a protective factor.

Relevance to clinical practice

The importance of incorporating programmes that mitigate these psychological effects and to promote adaptive coping styles during pandemics has become a need after what ICU professionals have gone through.

Mental Stress, Anxiety and Depressive Symptoms and Interleuken-6 Level among Healthcare Workers during the COVID-19 Pandemic

OBJECTIVES

This study aimed to evaluate the interleukin-6 (IL-6) levels and its relationship to stress, anxiety, and depressive symptoms among healthcare workers (HCWs) compared to controls during the COVID-19 pandemic.

METHODS

A total of 80 HCWs in Suez Canal University Hospital in Ismailia, Egypt, and 80 controls were analyzed during the COVID-19 pandemic. The Depression, Anxiety and Stress Scale (DASS 21) questionnaire was used, and serum IL-6 level was determined in both groups.

RESULTS

IL-6 levels were high in 81.2% (65) of HCWs compared to 36% (45) of controls (P < .05). The DASS score was higher in participants with high IL-6 levels (>3 ng/mL) than in those with mild to moderate levels (P < .05). The regression model revealed that the type of work as a healthcare staff, irregular or night shift, and stress were predictors of increased IL-6 levels among the studied sample (P < .05) (odds ratio = 20.30, 2.44, and 2.04, respectively).

CONCLUSION

The IL-6 level and DASS score were higher in HCWs compared to those in controls during the COVID-19 pandemic. The type of work as a healthcare staff, stress, and irregular or night shift were predictors of increased IL-6 levels.

Working during a Pandemic between the Risk of Being Infected and/or the Risks Related to Social Distancing: First Validation of the SAPH@W Questionnaire

BACKGROUND

The COVID-19 pandemic led the worldwide healthcare system to a severe crisis in which personnel paid the major costs. Many studies were promptly dedicated to the physical and psychological consequences of the COVID-19 exposure among healthcare employees, whereas the research on the other working populations has been substantially ignored. To bridge the current lack of knowledge about safe behaviors related to the risk of COVID-19 contagion at work, the aim of the study was to validate a new tool, the SAPH@W (Safety at Work), to assess workers' perceptions of safety.

METHODS

A total of 1085 participants, employed in several organizations sited across areas with different levels of risk of contagion, completed an online questionnaire. To test the SAPH@W validity and measurement invariance, the research sample was randomly divided in two.

RESULTS

In the first sub-sample, Confirmatory Factor Analysis demonstrated the adequacy of the SAPH@W factorial structure. In the second sub-sample, multi-group Confirmatory Factor Analysis revealed that the SAPH@W was invariant across gender, ecological risk level, and type of occupation (in-person vs. remote working).

CONCLUSIONS

The study evidenced the psychometric properties of the SAPH@W, a brief tool to monitor workers' experiences and safety perceptions regarding the COVID-19 risk in any organisational setting.

Predictors of Burnout in Social Workers: The COVID-19 Pandemic as a Scenario for Analysis

The current health crisis resulting from the COVID-19 pandemic increases the stress and anxiety levels in some professions, including social work. The present research aimed to determine the burnout levels of social workers in Spain during the first wave of the pandemic and the predictive variables. The methodological approach used was developed from a quantitative perspective through a simple random sampling from the Maslach Burnout Inventory (MBI) on a sample of Spanish social workers. The results showed high levels of emotional exhaustion (70.1%) and depersonalization (48.5%), although the data related to a reduced sense of personal accomplishment (36.6%) was low. The burnout level was 20.4%, a reduced record considering the values of the first two subscales. In contrast, the logistic regressions carried out showed that teleworking and psychological treatment are predictive variables of emotional exhaustion. With depersonalization, age (41-50 years) and the perception of needing psychological or psychiatric treatment in the future act as predictive variables. In critical scenarios such as a pandemic, work organizations should implement measures to reduce the high percentages of emotional exhaustion, the workload, and the dehumanization of professionals, a consequence linked to depersonalization.

Front-line nurses' responses to organisational changes during the COVID-19 in Spain: A qualitative rapid appraisal

Aims

To identify the organisational changes faced by front‐line nurses working with COVID‐19 patients during the first wave and describe how they responded to these changes.

Background

The COVID‐19 pandemic has altered the provision of care and the management of health care around the world. Evolving information about SARS‐CoV‐2 meant that health care facilities had to be reorganised continually, causing stress and anxiety for nurses.

Methods

Qualitative study based on Rapid Research Evaluation and Appraisal (RREAL). The research took place in hospital and community health settings of the Spanish national health system with a purposive sampling of 23 front‐line nurses. Semi‐structured interviews were conducted between May and June 2020. The duration was 30–45 min per interview. We used the Dedoose® data analysis software to perform a thematic analysis.

Results

Nurses responded to organisational changes using the following strategies: improvisation, adaptation and learning.

Conclusion

Our rapid approach allowed us to record how nurses responded to changing organisation, information that is easily lost in a disaster such as the COVID‐19.

Implications for nursing management: Knowing about their strategies can help planning for future health disasters, including subsequent waves of the COVID‐19.

Death Anxiety in Social Workers as a Consequence of the COVID-19 Pandemic

The COVID-19 pandemic has affected all social spaces, conditioning our daily routines, including those at work. All professions have been affected by stressful situations and anxiety in the proximity's face of death generated by the pandemic. In this context, some professionals have emerged as essential, as social workers, acting in extreme situations in the face of increased demands and social uncertainty arising from the health crisis. The present study aimed to determine the levels of anxiety about death among social workers in Spain. For this purpose, an ad hoc questionnaire was designed, taking the Collett and Lester Fear of Death Scale as a reference (n = 304). The exploitation of the data was carried out from a quantitative perspective. First, a descriptive analysis was performed. Then, binary logistic regressions were carried out on the general scale. The dependent variable in all of them was the risk of suffering death anxiety to the set of its subscales. The main research results show high values of this anxiety in social workers concerning the general value of the scale-and the subscales-and the point of view of state and process. The highest values were Fear of Death of Others (81.6%) and Fear of the Process of Dying of Others (78.3%). Regarding the binary logistic regressions applied, predictor variables were identified in all of them, but the following stand out: Lack of personal protection equipment and Need psychological or psychiatric support. In addition, being a woman increases the risk of suffering Fear of the Dying Process of others.

The Role of Healthcare Professionals' Passion in Predicting Secondary Traumatic Stress and Posttraumatic Growth in the Face of COVID-19: A Longitudinal Approach

COVID-19 has increased the likelihood of healthcare professionals suffering from Secondary Traumatic Stress (STS). However, the difficulty of this crisis may lead these professionals to display personal resources, such as harmonious passion, that could be involved in posttraumatic growth. The goal of this study is to examine the STS and posttraumatic growth among healthcare professionals and the demands and resources related to COVID-19. A longitudinal study was carried out in April 2020 (T1) and December 2020 (T2). The participants were 172 health professionals from different health institutions and they reported their workload, fear of contagion, lack of staff and personal protection equipment (PPE), harmonious passion, STS and posttraumatic growth. The results revealed that workload and fear of contagion in T2 were positive predictors for STS, whereas harmonious passion was a negative predictor. Fear of contagion of both times seemed to positively predict posttraumatic growth, as well as harmonious passion. One moderation effect was found concerning the lack of staff/PPE, as posttraumatic growth was higher when the workload was high, especially in those with a high lack of staff/PPE. All in all, these findings pointed out the need for preventative measures to protect these professionals from long-term negative consequences.

Variables associated with COVID-19 severity: an observational study of non-paediatric confirmed cases from the general population of the Basque Country, Spain

OBJECTIVES

To investigate which were the most relevant sociodemographic and clinical variables associated with COVID-19 severity, and uncover how their inter-relations may have affected such severity.

DESIGN

A retrospective observational study based on electronic health record data.

PARTICIPANTS

Individuals ≥14 years old with a positive PCR or serology test, between 28 February and 31 May 2020, belonging to the Basque Country (Spain) public health system. Institutionalised and individuals admitted to a hospital at home unit were excluded from the study.

MAIN OUTCOME MEASURE

Three severity categories were established: primary care, hospital/intensive care unit admission and death.

RESULTS

A total of n=14 197 cases fulfilled the inclusion criteria. Most variables presented statistically significant associations with the outcome (p<0.0001). The Classification and Regression Trees recursive partitioning methodology (based on n=13 792) suggested that among all associations, those with, age, sex, stratification of patient healthcare complexity, chronic consumption of blood and blood-forming organ, and nervous system drugs, as well as the total number of chronic Anatomical Therapeutic Chemical types were the most relevant. Psychosis also emerged as a potential factor.

CONCLUSIONS

Older cases are more likely to experience more severe outcomes. However, the sex, underlying health status and chronic drug consumption may interfere and alter the ageing effect. Understanding the factors related to the outcome severity is of key importance when designing and promoting public health intervention plans for the COVID-19 pandemic.

Burnout among Direct-Care Workers in Nursing Homes during the COVID-19 Pandemic in Spain: A Preventive and Educational Focus for Sustainable Workplaces

Due to their continuous contact with pain and death, healthcare workers have one of the most stressful professions. Pain and death are more common in nursing homes. During the health crisis associated with COVID-19, these work centers have been characterized as spaces of high vulnerability to infection for the elderly, with a high mortality rate. This research aims to determine how the health crisis associated with COVID-19 has influenced healthcare professionals working in nursing homes for the elderly. Using a quantitative and cross-sectional method, the research was developed in residential centers in the Region of Murcia (Spain) during the second wave of the pandemic. A survey design based mainly on the Maslach Burnout Inventory (MBI) was employed. MBI measures three subscales: emotional burnout, depersonalization, and self-fulfillment. The results show that 6.4% of the respondents were burned out, 53.8% of the participants were emotionally exhausted, 35.1% were found to suffer from depersonalization, and in the case of personal development, the respondents showed a low level of 15.6%. This study shows the need to consider the establishment, in the academic environment, of training programs for health professionals related to coping with, managing, and identifying stress, especially in adverse circumstances. Similarly, in the professional field, it is necessary to develop strategies to prevent stress and anxiety in the workplace. The development of training programs for this purpose is essential for achieving a sustainable work context.

A Systematic Review and Meta-Analysis of Burnout Among Healthcare Workers During COVID-19

Burnout among healthcare personnel has been exacerbated by the COVID-19 pandemic's unique features. During the COVID-19 pandemic, this systematic review and meta-analysis aims to provide a complete assessment of the prevalence of burnout across various healthcare personnel. Until January 2021, systematic searches for English language papers were conducted using PubMed, Scopus, EMBASE, Web of Science, Cochrane Library, and ProQuest. Thirty observational studies were found after conducting systematic searches. The pooled overall prevalence of burnout was 52% [95% confidence interval (CI) 40-63%]. Pooled emotional exhaustion (EE), depersonalization (DP), and lack of personal accomplishment (PA) were 51% (95% CI 42-61%), 52% (95% CI 39-65%), and 28% (95% CI 25-31%), respectively. This study demonstrated that nearly half of the healthcare workers experienced burnout during the COVID-19 pandemic. In the studies that were included, non-frontline COVID-19 exposed healthcare personnel also experienced burnout. From high to lower middle-income countries, there was a gradient in the prevalence of total burnout, EE, and lack of PA. Further studies on burnout in low and lower-middle-income countries are suggested. A uniform diagnostic tool for the assessment of burnout is warranted.

Emotional Experience and Feelings during First COVID-19 Outbreak Perceived by Physical Therapists: A Qualitative Study in Madrid, Spain

Knowing the experiences and feelings of health professionals who have actively worked on the first-line during the first COVID-19 outbreak could help for identifying specific professional duties focused on health assistance objectives. No qualitative study has been published describing the emotion/feelings of physical therapists during the first COVID-19 outbreak. This study describes and explores the emotional experiences and feelings of thirty physical therapists working at the first-line at eleven public health hospitals in Madrid (Spain) during the first COVID-19 outbreak (March–May 2020). A qualitative exploratory study was conducted based on an interpretive framework. Participants were recruited by purposeful sampling and snow-ball techniques between May and June 2020. In-depth interviews and researchers’ field notes were used to collect the data. An inductive thematic analysis was conducted to identify significant emerging themes from verbatim transcription. After identifying 2135 codes and 9 categories, three themes emerged to describe their emotional experiences and feelings. First, “Critical events”, with negative and positive critical events. Second theme, “Emotional Roller Coaster”, with emotions, feelings, and coping strategies. Third theme: “Last words: Conclusions of the COVID-19 outbreak experience”, with the meaning of the COVID-19 outbreak from a personal and professional perspective. Comprehensive support for all first-line healthcare professionals is needed.

Hearing the Voices of Wingless Angels: A Critical Content Analysis of Nurses' COVID-19 Experiences

The world has been affected by an outbreak of the novel coronavirus (COVID-19). Health care workers are among those most at risk of contracting the virus. In the fight against the coronavirus, nurses play a critical role. Still, most social media platforms demonstrate that nurses fear that their health is not being prioritized. The purpose of this study is to investigate nurses' experiences through analyzing the main themes shared on Instagram by nurses during the COVID-19 pandemic. In contrast with highly structured research, the current paper highlights nurses' natural language use in describing their experiences during the first months of the outbreak in their workplace. Instagram captions were utilized as a data source. Leximancer was utilized for the content analysis of nurses' narratives towards their coronavirus experience. We sought to accomplish three research objectives: the first was to identify the main themes in the descriptions of nurses' experiences shared via their social media, specifically Instagram; then, to determine the relationships among concepts, and finally, to give useful implications based on the findings. The current study uses a qualitative (i.e., narratives) approach to analyze the main components of the nurses' experiences during the pandemic. The Leximancer software analysis revealed nine major textual themes and the relationships among these themes. In order of the relative importance, the themes were "patients", "coronavirus", "exhaustion", "family", "hospital", "personal protective equipment" (PPE), "shift", "fear", and "uncertainty". The results offer practical implications based on the social media information regarding nurses' overall experiences.

COVID-19 Pandemic and Death Anxiety in Security Forces in Spain

The pandemic caused by the SARS-CoV-2 coronavirus, which produces COVID-19 disease, has revealed to political and social circles a series of needs that have not yet been met. The workers of the State Security Forces and the Armed Forces have done an extraordinary job to try to alleviate the effects that the pandemic has had on the population and to return stability to the citizenry as much as possible. In this context, the following investigation is developed based on two objectives: (PO1) to know the level of anxiety in the face of death in these professionals; (PO2) to determine the predictive variables in the above-mentioned phenomenon. Professionals from all over Spain have participated in the study (n = 2079). From a quantitative perspective, a questionnaire was developed from the Collet-Lester death anxiety scale. The results show a total level of 69.2% in the scale, as well as some higher levels about the fear of death of others (82.1%) and the fear of the process of dying of others (78.2%). On the other hand, from the binary logistic regressions, four variables are evidenced that condition the risk of suffering death anxiety: (a) certainty of needing psychological treatment in the future; (b) absence of Individual Protection Equipment (PPE); (c) high levels of Emotional Exhaustion; (d) high levels of depersonalization-these last two come from the Maslach and Jackson Burnout scale. These data show a need for training and intervention in the emotional and psychological demands of the professionals of the Armed Forces and State Security Forces, as well as the obligation to develop a continuous dialogue with the institutions they represent to foster the feeling of belonging to them. It is essential, regardless of the serious consequences that the virus has caused, to understand the psychosocial and emotional demands of enforcement agents and to improve their occupational health.